The Clinical Significance of Poor Bladder Compliance
Department of Urology, Seoul National University College of Medicine, Seoul, South Korea. Neurourology and Urodynamics
(Impact Factor: 2.87).
11/2009; 28(8):1010-4. DOI: 10.1002/nau.20713
There is limited data on bladder compliance associated with lower urinary tract dysfunction. The aim of this study was to investigate the decrease in bladder compliance, and the clinical relationship between patterns of increased pressure with neurological disease.
A retrospective analysis was performed in 5,027 patients with voiding dysfunction between June 2002 and April 2008. The patients with poor compliance (PC) were categorized according to the detrusor pattern of increased pressure: group A (gradual increase), group B (terminal increase), and group C (abrupt increase and plateau).
Patients with PC were found in 170 (3.4%) cases (76 males and 94 females) with 46.5% in group A 44.7%, group B, and 8.8% group C. Bladder trabeculation was more prevalent in patients with PC than among those with normal compliance. Group A had the highest correlation with the incidence of spinal cord injury compared to the other groups. Group B had a higher correlation with a history of pelvic irradiation, radical prostatectomy, and tethered cord syndrome compared to the others. Vesicoureteral reflux was more frequently detected in group A and group C. Group C was positively correlated with the presence of detrusor overactivity and nocturnal enuresis.
Poor compliance was correlated with the presence of neurological conditions. The gradual increase of detrusor pressure was associated with the development of spinal cord injury, and the terminal increase had an association with a history of treatment to the pelvic cavity.
Available from: Joongyub Lee
- "Urodynamic studies (UDS) were conducted before, 10 days, and 6 months after RH. UDS were performed by the same examiners according to the same protocol (UD-2000, Medical Measurement System, Enschede, the Netherlands) throughout the study period [6,11]. The changes in maximal cystometric capacity (MCC) and BC among the three periods were measured. "
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ABSTRACT: Lower urinary tract dysfunction is the most common complication after radical pelvic surgery. The aims of this study were to assess the effect of radical hysterectomy (RH) on the storage function of the lower urinary tract and to evaluate the impact of radiation therapy (RT) on postoperative urodynamic parameters.
This was a retrospective review of preoperative and postoperative urodynamic variables, which were prospectively collected. All women from 2006 to 2008, who underwent RH for uterine cervical cancer with a stage of 1A to 2B with or without adjuvant RT were enrolled. All patients were divided into two groups: group 1, without RT, and group 2, with adjuvant RT. Urodynamic studies were performed before, 10 days after, and 6 months after RH.
A total of 42 patients with a mean (±standard error) age of 51.9 (±12.3) years were analyzed. There were no significant differences in age, body mass index or clinical stage between the two groups. On the 10th postoperative day, all parameters were decreased except postvoid residual volume. In comparison with group 2 (n=14), group 1 (n=28) showed a significant increase in bladder compliance. At 6 months postoperatively, bladder compliance in group 1 had increased four times or more compared with that on postoperative 10 days. However, it had increased only 2.5 times in group 2 at the same time point (P<0.001).
The results of our study suggest that adjuvant RT after RH might result in a deterioration of bladder compliance. It is highly suggested that practitioners pay attention to low bladder compliance, especially in patients who have adjuvant RT after RH.
Available from: Chuangyu qu
- "Briefly, it was derived from EAS EMG and was expressed as [lg (potentials before voiding/at Qmax)] with a negative number (<0) indicating that the sphincter activity was abnormally increased during voiding. The detrusor contraction fashion in DUA-NC was low sustained (Fig. 3a), whereas those in DUA-LC was high sustained as the Pdet had reached a relatively high level prior to ordering voiding and did not increase during the voiding phase (Fig. 4a) [12, 13]. If effective detrusor contraction pressure was claimed, the Pdet ahead of the voiding order should be subtracted from the real-time Pdet. "
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ABSTRACT: The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency.
A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment.
After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05).
LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.
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ABSTRACT: A network, which can learn temporal patterns incrementally, is proposed. The network uses: a) Gaussian functions to represent various output values and b) chunking to group similar patterns so that a compact network can be realized. The learning capacity limits of the network are evaluated for the worst case sequences. Learning of sequences can be performed using a simple one step algorithm.
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